The importance of intra-amniotic inflammation in the subsequent development of atypical chronic lung disease
The importance of intra-amniotic inflammation in the subsequent development of atypical chronic lung disease
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DOI：
10.1080/14767050902994705
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发表时间：
2009-01-01
影响因子：
1.8
通讯作者：
Yoon, Bo Hyun
中科院分区：
文献类型：
--
作者：
Lee, Joonho;Oh, Kyung Joon;Yoon, Bo Hyun
Objective.研究目的：探讨羊膜腔内炎症是否为非典型慢性肺疾病（CLD）的危险因素。对72例在子宫穿刺术后5天内分娩早产儿（胎龄：24-32周）且其新生儿随后发生CLD的患者进行了回顾性队列研究。非典型CLD定义为不伴呼吸窘迫综合征（RDS）的CLD。羊水中基质金属蛋白酶-8（MMP-8）浓度升高（>23 ng/ml）即为羊膜内炎症。(1)非典型CLD的检出率为54.2%（39/72），（2）非典型CLD与CLD合并RDS的婴儿出生时中位孕龄及产前皮质类固醇使用率无显著性差异;（3）非典型CLD早产儿AF MMP-8浓度中位数显著高于非典型CLD早产儿AF MMP-8浓度中位数。（中位值373.1 ng/ml vs. 8.6 ng/ml，p=0.003）和中位AF白色血细胞计数（中位数450.0/mm（3）vs. 5.5/mm（3），p=0.009），羊膜内炎症的发生率（74.4% vs. 45.5%，p=0.012）高于CLD合并RDS的患者。羊膜内炎症导致非典型CLD的风险高于典型CLD伴初始RDS。这项新的观察结果强化了产前炎症作为肺损伤机制的重要性。
Objective. To examine whether the intra-amniotic inflammation is a risk factor for the development of atypical chronic lung disease (CLD).Study design. A retrospective cohort study was undertaken in 72 patients who delivered preterm neonates (gestational age: 24-32 weeks) within 5 days of amniocentesis and whose neonates subsequently developed CLD. Atypical CLD was defined as CLD without respiratory distress syndrome (RDS). Intra-amniotic inflammation was defined as an elevated amniotic fluid (AF) concentration of matrix metalloproteinase-8 (MMP-8) (>23 ng/ml).Results. (1) Atypical CLD was identified in 54.2% (39/72) of cases with CLD; (2) there were no significant differences in the median gestational age at birth and the rate of antenatal corticosteroid use between infants with atypical CLD and CLD with RDS; (3) preterm newborns with atypical CLD had a significantly higher median AF MMP-8 concentration (median 373.1 ng/ml vs. 8.6 ng/ml, p=0.003) and median AF white blood cell count (median 450.0/mm(3) vs. 5.5/mm(3), p=0.009), and a higher rate of intra-amniotic inflammation (74.4% vs. 45.5%, p=0.012) than those with CLD with RDS.Conclusion. Intra-amniotic inflammation confers a greater risk for atypical CLD than for typical CLD with initial RDS. This novel observation strengthens the importance of prenatal inflammation as a mechanism of lung injury.